Employment Application

We are an Equal Employment Opportunity employer and are always looking for qualified workers. If you are interested in joining a team that is dedicated to quality workmanship you can fill
out our secure online application or you can download our employment application, fill it out, and email it to daisy@broughmanbuilders.com or mail it to Broughman Builders, 6 Acadia Way, Ellsworth, ME 04605.

Applicant Information

First Name:

Middle Name:

Last Name:

Date of Birth:

Address:

City:

State:

Zip:

Phone:

Mobile Phone:

Email:

What position(s) are you interested in?

Desired Salary:

Date Available:

Are you a citizen of the United States?

If no, are you authorized to work in the U.S.?

Have you ever worked for this company?

If yes, when?

Have you ever been convicted of a felony?

If yes, please explain?

Education

High School:

Address:

From:

To:

Did you graduate?

Diploma:

College / University:

Address:

From:

To:

Did you graduate?

Degree:

Other:

Address:

From:

To:

Did you graduate?

Degree:

References

Reference Name:

Relationship:

Company:

Phone:

Address:

Reference Name:

Relationship:

Company:

Phone:

Address:

Reference Name:

Relationship:

Company:

Phone:

Address:

Previous Employment

Company Name:

Address:

Supervisor:

Phone:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason For Leaving:

May we contact your previous supervisor for a reference?

Company Name:

Address:

Supervisor:

Phone:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason For Leaving:

May we contact your previous supervisor for a reference?

Company Name:

Address:

Supervisor:

Phone:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From:

To:

Reason For Leaving:

May we contact your previous supervisor for a reference?

Disclaimer & Verification

By entering my initials below, I certify that my answers are true and complete to the best of my
knowledge. If this application leads to employment, I understand that false or misleading
information in my application or interview may result in my release.